Athletes the world over are continuously searching for new ways to one-up their competition. Better training, improved technique, innovative coaching. In sports, if not always in life, there are clear winners and losers, and, often, the winners are the ones who can combine natural talent with the best and brightest advantages training and coaching have to provide. When the advantage comes from the latest and greatest gadget or gear, coaching style, or training regimen, competitors are just sorry they did not find it first. But, when the advantage comes from performance-enhancing drugs, the line between winners and losers gets a little blurry. And now, there are some sports gurus and bioethicists who wonder if legalizing performance-enhancing drugs is, in fact, a fair play.

The desire to succeed in sports has led many athletes to use so-called doping substances to enhance performance. Doping agents include anabolic steroids, human growth hormone, creatine, protein supplements, minerals, antioxidants, stimulants, erythropoietin, beta-blockers, and inhaled beta-agonists, among other substances. Most of these drugs and substances have a place in the appropriate management of defined disease states under the care of an experienced medical professional. However, when they are used without proper medical guidance and knowledge of the risks and benefits, the potential for physical and psychological damage is enormous. Most of these substances have been designated as banned by the World Anti-Doping Agency, making users of the substances ineligible for competition in most mainstream sporting events.

One survey of Olympians reports that 90% of athletes believe doping substances have positive, performance-enhancing effects. (For most of the substances, however, little or no data confirm this belief.) Nearly one-third of the athletes admitted personally knowing someone who has used a banned doping substance, and 15% were offered such a substance during their athletic career. Stimulants and anabolic steroids are the most cited drugs, in terms of availability and benefit, according to these athletes. Athletes engaged in competitions of speed and power is the most-often approached group when it comes to doping opportunities. Overall, the athletes did not view doping as a major health risk, an attitude that needs to be addressed, according to many experts.

Similarly, another analysis of young male athletes reports that shame, not health consequences, is the primary reason that athletes do not engage in doping. Injury recovery and economics of elite sports reportedly encourage doping. A large group of the athletes acknowledged that they would use a banned doping substance under conditions of guaranteed success and undetectability.

In an argument somewhat akin to the medical marijuana debate (If they’re going to do it, let’s control it.), some supporters of legalizing banned doping substances posit that it is better to know when people are engaging in unhealthy or risky behavior than it is to not know. Plus, if doping were made legal, it would be provided under medical supervision, leading to a decline in the number of adverse health consequences, and the related costs, currently associated with doping. Unfortunately, some doping cases are already provided under supervised medical care, with physicians diagnosing medical conditions and prescribing some of the banned substances for “therapeutic use”. The clinical judgment skills in such cases are misguided at best.

Another argument brings to mind the age-old question about jumping off a bridge if all your friends were doing it. The fairness argument claims that legalizing doping substances would level the playing field, allowing all athletes to compete with access to the same performance-enhancing techniques. Supporters further elaborate that the substances do not do the training for an athlete — he still needs to lift weights, run laps, or practice at-bats; doping just lets him do it better. In the end, though, the athlete with the best pharmacist wins.

Still another case for legalizing banned doping substances evokes prohibition-era moonshine, bootleggers, and speakeasies. The more a product is deemed illegal, the deeper underground it will go, making it even more dangerous, both physically and criminally. Most likely, legalizing doping substances will not set a firm line as to what is acceptable and what is not. It will merely move the line into more treacherous territory.

The cynics will claim that complete eradication of doping in sports is an impossibility, so embrace what is known, and educate athletes to use the substances responsibly. The idealist will recall that sports are beloved because they allow humans to go far beyond the potential that most people see in themselves, and in others. The winners in sports, as well as life, should be the ones who recognized the potential within themselves, worked hard to perfect their talents, and played fair until the end. To lose respect for the rules of the game, and ones competitors, is to sacrifice the gift of one’s talents.

Rogol AD (2009). Growth hormone and the adolescent athlete: What are the data for its safety and efficacy as an ergogenic agent? Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society, 19 (4), 294-9 PMID: 19487146

Why do you find it unfortunate that athletes are receiving medical treatment? Shouldn’t athletes who have medical problems be prescribed drugs that are therapeutically indicated (even if the are prohibited by WADA)? This is the entire point of the therapeutic use exemption (TUE).

How could you consider a physician “misguided” by prescribing the very same medications to athletes that they would to any other individual who have similar medical problems?

This bias is not informed by science or motivated by a clinician advocating proper medical care in such cases. It represents a moral bias more than anything. A clinician should never compromise the health of a patient based on some self-subscribed morality.

From your article: “Unfortunately, some doping cases are already provided under supervised medical care, with physicians diagnosing medical conditions and prescribing some of the banned substances for “therapeutic use”. The clinical judgment skills in such cases are misguided at best.”

ChristianKl

There another benefit of legalizing doping:
More research into performance enhancement could be published. Science as a whole would profit if the knowledge that’s presently gathered in dark would come to light.

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.

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